超声引导下右侧星状神经节阻滞与右侧膈神经阻滞对妇科腹腔镜手术后肩痛的影响

Effect of ultrasonic-guided right stellate ganglion block and right phrenic nerve block on shoulder pain after gynecological laparoscopic surgery

目的探究超声引导下右侧星状神经节阻滞(R-SGB)与右侧膈神经阻滞(R-PNB)治疗妇科腹腔镜手术后肩痛的效果。方法选取2022年2月至2023年2月于赣州市妇幼保健院行妇科腹腔镜手术的60例患者作为研究对象,随机分为对照组、实验1组与实验2组,每组20例。对照组给予右美托咪啶(DEX)治疗,实验1组给予DEX联合R-PNB治疗,实验2组给予DEX联合R-SGB治疗。比较3组血流动力学指标、血清炎症因子水平、肩部视觉模拟评分法(VAS)评分、Ramsey镇静评分、舒适评分、止痛药用量及不良反应发生情况。结果气管插管即刻(T2)、气腹后5min(T3)时,实验1组和实验2组HR均慢于对照组,T3时,实验1组MAP低于对照组,差异有统计学意义(P<0.05);3组其他时间MAP、HR两两比较差异无统计学意义。术后12h(T7)时,实验1组和实验2组TNF-α、IL-6水平均低于对照组,差异有统计学意义(P<0.05),实验1组与实验2组TNF-α、IL-6水平比较差异无统计学意义。术后1h(T5)~术后48h(T9)时,实验1组和实验2组VAS评分均低于对照组,Ramsey镇静评分均高于对照组,差异有统计学意义(P<0.05),实验1组与实验2组VAS和Ramsey镇静评分比较差异无统计学意义。实验1组和实验2组舒适评分均高于对照组,止痛药用量均少于对照组,差异有统计学意(P<0.05),实验1组与实验2组舒适评分和止痛药用量比较差异无统计学意义。3组不良反应发生率比较差异无统计学意义。结论超声引导下R-SGB和R-PNB治疗妇科腹腔镜手术后肩痛中均能有效改善患者术后疼痛,疗效较好。

Objective To explore the effect of ultrasonic-guided right stellate ganglion block(R-SGB)and right phrenic nerve block(R-PNB)in the treatment of shoulder pain after gynecological laparoscopic surgery.Methods 60 patients who received gynecological laparoscopic surgery in Ganzhou Maternal and Child Health Hospital from February 2022 to February 2023 were selected as the study subjects,and they were randomly di-vided into the control group,the experimental group 1 and the experimental group 2,with 20 cases in each group.The control group was treated with dexmedetomidine(DEX),the experimental group 1 was treated with DEX combined with R-PNB,and the experimental group 2 was treated with DEX combined with R-SGB.The hemodynamic indexes,serum inflammatory factors levels,shoulder visual analogue scale(VAS)scores,Ramsey sedation score,comfort level,dosage of painkillers,and occurrence of adverse reactions were compared among the three groups.Results Immedi-ately after endotracheal intubation(T2)and 5 min after pneumoperitoneum(T3),the HR in the experimental group 1 and the experimental group 2 were slower than that in the control group,and at T3,the MAP in the experimental group 1 was lower than that in the control group,and the differenc-es were statistically significant(P<0.05);there was no significant difference in pairwise comparison of MAP and HR among the three groups at oth-er times.At 12 h after surgery(T7),the levels of TNF-αand IL-6 in the experimental group 1 and the experimental group 2 were lower than those in the control group,and the differences were statistically significant(P<0.05),there was no significant difference in TNF-αand IL-6 levels between the experimental group 1 and the experimental group 2.At 1 h after surgery(T5)to 48 h after surgery(T9),the VAS score in the experimental group 1 and the experimental group 2 were lower than that in the control group,Ramsey sedation score were higher than that in the control group,and the dif-ferences were statistically significant(P<0.05),there were no significant differences in VAS and Ramsey sedation scores between the experimental group 1 and the experimental group 2.The comfort scores in the experimental group 1 and the experimental group 2 were higher than those in the control group,and the dosage of painkillers were less than that in the control group,the differences were statistically significant(P<0.05),there was no significant difference in comfort scores and dosage of painkillers between the experimental group 1 and the experimental group 2.There was no significant difference in the incidence of adverse reactions among the three groups.Conclusion Both R-SGB and R-PNB can effectively the postoperative pain of patients with shoulder pain after gynecological laparoscopic surgery,and the efficacy is good.